Estimating Lost Life-Years and Quality-Adjusted Life-Years of Undertreatment of Patients With Renal Cell Carcinoma and Metastatic Pancreatic Cancer in England
Author(s)
Vladislav Berdunov, PhD1, Robert J. Hughes, MSc1, Meredith Smith, MPA, PhD, FISPE2.
1PPD Evidera Health Economics and Market Access/Thermo Fisher Scientific, London, United Kingdom, 2Evidera, Inc., PPD a part of Thermo Fisher Scientific, Remote, MA, USA.
1PPD Evidera Health Economics and Market Access/Thermo Fisher Scientific, London, United Kingdom, 2Evidera, Inc., PPD a part of Thermo Fisher Scientific, Remote, MA, USA.
OBJECTIVES: Recent cancer audits have identified significant proportions of patients not receiving NICE-recommended treatments. While this may be partly explained by patient suitability and/or preferences, these factors collectively do not sufficiently explain the observed shortfall. This study explored the impact of undertreatment and estimated the potential lost health.
METHODS: NHS England-commissioned audit data since 2024 were reviewed to identify key cancer indications where underutilisation of recommended chemotherapy could not be fully explained by preferences, or treatment unsuitability. Case studies were developed for metastatic renal cell carcinoma (mRCC) and metastatic pancreatic cancer (mPC), based on data availability and the audit findings. Untreated patient numbers were estimated using audit data. NICE-recommended therapies were compared to untreated patients to estimate the potential life-year and quality-adjusted life year (QALY) gain for treating patients with NICE-recommended therapies. A major challenge was an absence of placebo-controlled trials to inform outcomes for untreated patients, therefore, these outcomes were proxied using the treatment option with the lowest health outcomes reported in relevant NICE appraisals. The results were subject to substantial uncertainty, and conservative assumptions were used where possible.
RESULTS: An estimated 3,319 and 2,509 patients could potentially benefit from chemotherapy annually for mPC and mRCC, respectively. If these patients received the recommended therapy, an additional 1,269 (plausible range 674-2218) life years and 877 (481-1180) QALYs for patients with mPC, and 2,333 (1,593-2,567) life years and 1,380 (1,019-1,573) QALYs for patients with mRCC could be gained.
CONCLUSIONS: While full treatment uptake in clinical practice is unlikely, this analysis highlights the potential burden from treatment underutilisation for late-stage cancer patients. Our results are consistent with substantial research showing that the development of clinical practice guidelines alone does not necessarily translate into changes in clinical practice behaviour or improved patient outcomes but may require specific strategies to facilitate their uptake and adoption into clinical care.
METHODS: NHS England-commissioned audit data since 2024 were reviewed to identify key cancer indications where underutilisation of recommended chemotherapy could not be fully explained by preferences, or treatment unsuitability. Case studies were developed for metastatic renal cell carcinoma (mRCC) and metastatic pancreatic cancer (mPC), based on data availability and the audit findings. Untreated patient numbers were estimated using audit data. NICE-recommended therapies were compared to untreated patients to estimate the potential life-year and quality-adjusted life year (QALY) gain for treating patients with NICE-recommended therapies. A major challenge was an absence of placebo-controlled trials to inform outcomes for untreated patients, therefore, these outcomes were proxied using the treatment option with the lowest health outcomes reported in relevant NICE appraisals. The results were subject to substantial uncertainty, and conservative assumptions were used where possible.
RESULTS: An estimated 3,319 and 2,509 patients could potentially benefit from chemotherapy annually for mPC and mRCC, respectively. If these patients received the recommended therapy, an additional 1,269 (plausible range 674-2218) life years and 877 (481-1180) QALYs for patients with mPC, and 2,333 (1,593-2,567) life years and 1,380 (1,019-1,573) QALYs for patients with mRCC could be gained.
CONCLUSIONS: While full treatment uptake in clinical practice is unlikely, this analysis highlights the potential burden from treatment underutilisation for late-stage cancer patients. Our results are consistent with substantial research showing that the development of clinical practice guidelines alone does not necessarily translate into changes in clinical practice behaviour or improved patient outcomes but may require specific strategies to facilitate their uptake and adoption into clinical care.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR71
Topic
Economic Evaluation, Health Policy & Regulatory, Health Service Delivery & Process of Care
Disease
Oncology